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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Big Springs, Ky
Inc Town:  [unreadable] Big Springs, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  5314
Primary Registration District No:  14
File No.  12271
Registered No:  15
2. FULL NAME:  Lizzie Sipes
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  August 25, 1839
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  73 years, 8 months, 19 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  at home of daughter
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckenridge County, Ky
10. NAME OF FATHER:  William Kasey
11. BIRTHPLACE OF FATHER:  Not Known
12. MAIDEN NAME OF MOTHER:  Malinda Dent
13. BIRTHPLACE OF MOTHER:  Not Known
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Robert Lockard
(Address)  Big Spring, Ky
15. Filed  May 17, 1913
REGISTAR:  J. L. Morris
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  May 14, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  April 12 to May 14, 1913
That I last saw him/her alive on (date):  April 21, 1913
And that death occurred on the date stated above at (time AM/PM):  6:30 PM
THE CAUSE OF DEATH was as follows:  Laryngeal Tuberculosis
 
(Duration)   Years:     1       Months:    2        Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. B. Witt
Date:  May 15, 1913
Address:  Big Spring, Ky
18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19. PLACE OF BURIAL OR REMOVAL:  Sipes Cemetery
DATE OF BURIAL:  May 16, 1913
20. UNDERTAKER:  Robert Lockard
ADDRESS:  Big Spring, Ky
 

ADDITIONAL COMMENTS/NOTES:
 
 
 

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